Newsletter – May 2013

Wisdom and Compassion in Psychotherapy

My determination to integrate practices of mindfulness and compassion from the Buddhist wisdom tradition with practices of reflection and empathy from contemporary Western psychotherapy fueled, in large part, the research and writing of Bouncing Back: Rewiring Your Brain for Maximum Resilience and Renewal, now in bookstores and doing well.

That journey introduced me to both Chris Germer, PhD, and Ron Siegel, PhD (see Resources below for their credentials) and to their latest joint venture: Wisdom and Compassion in Psychotherapy: Deepening Mindfulness [and so much more!] in Clinical Practice.

Wisdom and Compassion in Psychotherapy is like 20+ TED talks from leading scholars, scientists, and clinicians skilled in all three paradigms, among them: Tara Brach, John Briere, Richard Davidson, Barbara Frederickson, Paul Gilbert, Marsha Linehan, Kristin Neff, and Dan Siegel.  Each contributor of a chapter has distilled into 10-15 pages the wisdom of a lifetime. And the book focuses on each of these three major paradigms – wisdom, compassion, and psychotherapy in a phenomenally clear and well- organized format.

His Holiness the Dalai Lama writes in his foreword:

Both the Buddhist mind-training tradition and Western psychotherapeutic tradition teach that our attitude toward our experience is often far more important to our happiness…[Linda’s note: and our resilience!] than our fleeting good or bad fortune.  In recent years, Western researchers and psychotherapists have discovered that principles and practices drawn from Buddhist psychology can be very helpful in alleviating the stress of modern life….They are learning that these teachings and practices have the potential to radically alter our understanding of ourselves and of one another, and can help us do our work more effectively.

While Wisdom and Compassion in Psychotherapy is written primarily for practitioners, clinical and/or mindful, the book offers an astonishing wealth of clues for all of us about how to tolerate, accept, and even grow from life’s difficulties and tragedies.  This month’s e-newsletter will introduce you to some of the major themes of the “TED talks,” including the neurobiological foundations of wisdom and compassion and the relationship of wisdom and compassion to psychological well-being, emotional suffering, and therapeutic change.

May these reflections and tools be useful to you and yours.

Reflections on Wisdom and Compassion in Psychotherapy

Part One: What Are Wisdom and Compassion? Why Should We Care?

Chris and Ron begin the deep diving of this book with their own discussion of the meaning of wisdom – a deep understanding of how to live life well – and compassion – the ability to relate empathically to emotional suffering with goodwill; then the intimate relationship of wisdom and compassion with each other, indistinguishable at the core of our being, and their relationship to mindfulness.

They briefly explore the history of compassion in Eastern and Western thought, including Darwin’s view that compassion is an instinct in the human species as innate as the more focused-on aggression and as essential for the survival of the species. They consider compassion a specific form of empathy –  empathy for the experience of suffering coupled with a desire to alleviate it.  And they cite the current research that indicates the practice of compassion helps people be less reactive to stress and demonstrate lasting improvements in happiness and self-esteem.

They likewise briefly trace the history of thought about wisdom, expanding their working definition of a deep understanding of how to live life well to other models such as MORE – Mastery, Openness to experience, a Reflective attitude, and Emotional regulation, or the factors of: pro-social attitudes/behaviors; pragmatic knowledge of life; emotional balance, reflective self-understanding, value relativism/tolerance and dealing effectively with uncertainty/ambiguity. (Robert Sternberg’s balance theory of wisdom in Chapter 11 is another formulation: the application of intelligence, creativity and knowledge as mediated by positive ethical values toward the acheivement of a common good.)

Wisdom and compassion are seen as the fruition of mindfulness, which helps us be with discomfort, disengage from our automatic responses, step out of a ruminative thought stream, and observe the moment-to-moment patterns of the mind.  We can see the part our mind plays in contributing to our suffering, develop compassion for that, generate insight, and embrace any opposites we need to reconcile. When we can see clearly, we can engage whatever we’re feeling with tenderness and ease and then respond effectively to emerging life circumstances.  We can shift the conversation from self-criticism and rumination to self-encouragement and possibilities.   The core concepts and practical paths of the book that help patients heal from stress, trauma, anxiety, loneliness, shame, or depressive withdrawal are anchored in the view that how we relate to our experience – tenderly-harshly, accepting-resisting, curious-avoidant – affects our sense of well-being even more than the conditions of our lives, making the practice of wisdom and compassion a trans-theoretical, trans-diagnostic process of change.

Part One continues with clinical psychologist and meditation teacher Tara Brach’s Chapter 2 on “Mindful Presence: A Foundation for Compassion and Wisdom.” Tara teaches that “It is through realizing and trusting our capacity for a wise and loving presence, through being that presence, that we discover freedom from suffering.  In the face of life’s greatest challenges, this timeless presence brings healing and peace to our own hearts and to the hearts of others.”

[See February 2013 e-newsletter on Tara Brach’s book True Refuge: Finding Peace and Freedom in Your Own Awakened Heart for more of her teachings.]

And with pioneering researcher in positive psychology Barbara Frederickson’s Chapter 3 on “Building Lives of Compassion and Wisdom.” Barbara offers clinical applications of her broaden and build theory – using positive emotions such as compassion and kindness to help our minds stay open to new possibilities and build new resources of creativity, social collaboration and resilience.

[See July 2012 e-newsletter for more on Barbara Frederickson’s research on Positive Emotions Build Resilience.]

Part II: The Meaning of Compassion. Among the “TED talks”:

In Chapter 4, “Compassion in Buddhist Psychology,” John Makransky, co-editor of Buddhist Theology: Critical Reflections by Contemporary Buddhist Scholars,  places compassion at the core of Buddhist psychology as one of the four mental states (along with loving kindness, joy, and equanimity) that awakens all of the positive states of mind that contribute to health and happiness; compassion awakens us to our fullest human potential.

In the Therevadan (insight) tradition, compassion is the practice that addresses three levels of suffering: obvious suffering (our common everyday human afflictions of grief, loss, illness and injury, aging and dying), the suffering of transience (wanting to hold on to what can’t be held onto) and the suffering of self-centered conditioning (notably, dwelling on an unnecessary disconnection from others and falsely reifying the ever-changing personal self.)

In the Mahayana (non-dual) tradition, compassion leads to a recognition of the ultimately deeply connected nature of all of existence.  The meditation practice of exchanging self and other helps us experience the interdependent ground of being that supports an all-embracing compassion for all creatures caught in suffering, no different from ourselves.

In the Vajrayana (Buddha nature) tradition, compassion is both the practice that allows us to realize the essential goodness of our true nature underlying all of our conditioning and is the state that naturally arises when we do realize that true nature.  (John Makransky’s book Awakening through Love: Unveiling Your Deepest Goodness offers many meditation practices to help the reader access this true nature.)

In Chapter 6, “The Science of Self-Compassion,” Kristen Neff, PhD, outlines her program of self-compassion practice that can be an underlying mechanism of therapeutic change:

Self-Kindness:  being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than flagellating ourselves with self-criticism. We clearly acknowledge our problems and shortcomings without judgment, so that we can do what’s necessary to help ourselves.  We can’t always get what we want.  We can’t always be who we want to be.  When this reality is denied or resisted, suffering arises in the form of stress, frustration, and self-criticism.  When this reality is accepted with benevolence, we generate positive emotions of kindness and care that help us cope.

Common Humanity:  One of the biggest problems with harsh self-judgment is that it tends to make us feel isolated.  When we notice something about ourselves we don’t like, we irrationally feel like everyone else is perfect and it’s only me who is inadequate.  Self-compassion recognizes that life challenges and personal failures are part of being human, an experience we all share.  In this way, it helps us to feel less desolate and isolated when we are in pain.

Mindfulness: You can’t ignore your pain and feel compassion for it at the same time.  The mental space provided by taking a mindful approach to our difficult feelings allows for greater clarity, perspective and emotional equanimity.

[See the September 2012 e-newsletter Self Compassion More Powerful than Self-Esteem for more of Kristen’s research on the different impacts of self-criticism, self-compassion, and self-esteem, including consistent research findings that self-compassion is linked to less anxiety, depression, and procrastination and leads to more motivation, emotional intelligence, and wisdom.]

In Chapter 7: co-editor Chris Germer explores Cultivating Compassion in Psychotherapy. He identifies what causes suffering as self-criticism, self-isolation, and self-absorption, patterns often learned in our earliest attachment relationships as well as from our culture.  He suggests we need to connect with emotional pain, not resist it or push it away,  for compassion to arise. “Life can be shallow if we glide over sorrow, more difficult if we fight it, and simply terrifying when we feel raw and unprotected.

Compassion is a skill that allows us to open to sorrow and not resist or contract around it.  We practice compassion not to feel better but because we feel bad. It is a uniquely healthy, spontaneous and intelligent response to suffering that transforms the experience of pain, even making it worthwhile. Compassion gives us the strength to abide with the vicissitudes of our lives.  We mindfully contact the pleasure and pain, sickness and health, gain and loss without drowning in them until we have an opportunity to change them. Compassion is practice of good will, not necessarily good feelings.   When we openheartedly accept ourselves – our emotional limitations, intellectual weaknesses, physical flaws – then we can approach our lives with greater humor and grace, see new possibilities, and succeed in key areas of our lives.

In therapy clients can learn and practice compassion exercises in compassion-informed, compassion-based, or compassion-focused therapy.  In compassion focused therapy, clients learn to evoke compassionate mind states to not only change the content of the internal dialogue of the self – criticism and shaming of the inner critic – but to change the emotional tone of the entire inner conversation, validating, empathize with and encouraging ourselves to feel whole and secure again, which can heal those earlier attachment wounds.

[See the January 2013 e-newsletter The Compassionate Mind for more on Paul Gilbert’s Compassion Focused Therapy]

In Chapter 8: “The Neurobiology of Compassion,” neuroscientist Richard Davidson describes the research done on compassion in his neuroimaging lab at the University of Wisconsin – Madison.  When expert meditators (more than 10,000 hours of practice) focused on generating a state of unconditional loving kindness and compassion, their EEGs recorded dramatic changes in brain wave activity (increased gamma wave activity, hypothesized as a major factor in the construction of conscious awareness) and increased neural synchrony – more of the brain working together at the same time- a factor in the quality of conscious awareness.

When the brain activity of meditators adept in compassion practice was measured in an functional magnetic resonance imaging scanner while they were meditating on compassion, dramatic changes were recorded in the structures of the brain involved in perception of pain (insula), empathy and sharing of emotions (amygdala), and perspective taking ( right parietal-temporal junction).

Davidson suggests that because of the brain’s innate neuroplasticity – the capacity to grow new neurons and create new connections among them – compassion is a skill that can be cultivated, even in relatively short periods of practice.  Hecomments, “Mental training may be just like physical training – part genetic predisposition, part environmental circumstance, enhanced by lots of intentional practice.” He continues to investigate how compassion training may very well contribute to overall health and well-being.

Part III  The Meaning of Wisdom.

Wisdom…is the capacity to stop the folly, turn our attention inward, dismantle our erroneous beliefs and self-deceptions, and build our lives in accord with how things actually are. C.G. and R.S.

In Chapter 9, “Wisdom in Buddhist Psychology,” Andrew Olendzki, author of Unlimiting Mind: The Radically Experiential Psychology of Buddhism, describes the core Buddhist insights into the nature of experience: that because experience is constructed moment by moment, any habits and beliefs that are built by the mind can be intentionally modified.  He uses a metaphor of consciousness as a chariot being steered by its driver across a dusty plain, the driver choosing where to go moment by moment.  Over time the chariot leaves tracks in the dirt, even creating ruts if driven along the same path over and over.  Rather than simply saying, “Life is suffering,” the Buddhist understanding is that our habitual responses to life constitute suffering.  Any of these pathways of learned behavior, patterns of neural firing created by the mind/brain can be changed by the mind/brain.

Although he didn’t understand it biologically as we do today, the Buddha clearly believed in neuroplasticity.  A.O.

Mindfulness is the primary tool for transforming beliefs into skillful modes of functioning.  Mindfulness develops the ability to catch a glimpse of what arises from the depth of the unconscious psyche as it passes through awareness on its way to initiating action. Aspects of experience to which we were entirely blind come into view, and the ability to choose one course of action over another becomes strengthened.  We learn how to drive the chariot more skillfully, avoiding the deep ruts that lead into danger and trouble, and to forge new pathways that will convey the mind into healthier, more meaningful environs.  Ultimately, mindfulness may even liberate awareness from the constraints of [reactions] altogether, allowing us to drive where we will and leave no tracks.

In the Buddhist view, our individual character, personality, self, are the collective functioning of a hundred thousand of these patterns or habits; some of them wise and skillful, some less so.  Mindfulness allows us to see these habits arise out of our unconscious moment by moment, see them as running toward experience (greed, grasping, compulsion) or running away from experience (denial, aversion, hatred) or being plain ole confused by experience (delusion).

The traditional Buddhist view is that greed, hatred, and delusion are the three primary colors out of which all suffering arises.  Mindfulness carves out a space between our underlying dispositions and the surge of actions they lead us to.  Mindfulness practice allows us to abide in the space between the stimulus and the response.  “Choices are always made, as we surge into the world with action; the question is whether or not we participate consciously in the process.”

For many of us, using mindfulness to see our experience clearly and choose our responses wisely would be transformative enough.  Olendzki explores further the ultimate purpose of mindfulness – which does get us underneath the common assumptions and responses and see more clearly how our minds construct reality – of developing a keener insight and wisdom into understanding the ultimate nature of all of reality.  That all of existence is impermanent, nothing is ever fixed forever; similar to modern physics, everything is in flux at all times.  Resisting that reality that everything changes creates psychological suffering; embracing the truth of that reality, and it takes practice to do this, can lead to profound well-being and happiness.  That all of existence is inter-dependent with all the rest of existence.  Insisting on identifying ourselves as different or separate from the rest of existence causes the suffering of loneliness, isolation, despair.  Embracing the inter-connectedness of our self with all of experience leads to profound well-being and happiness, imperturbable under any circumstances.

In Chapter 10, “The Wise Psychotherapist,” co-editor Ron Siegel explores common attributes of psychotherapists who could be considered wise:

* Awareness of the limitations of one’s own viewpoint, an ability to consider multiple viewpoints (including the patient’s), and an ability to tolerate uncertainty and ambiguity;

* Intelligence in the form of fluid intelligence – the ability to think logically and clearly and crystallized intelligence – using accumulated knowledge and experience to make sound judgments, and the open-mindedness to learn from experience;

* Insight/Intuition into another person’s perspectives and our own inner workings; and having a map of what living well looks and feels like.

* Reflective attitude – thinking deeply and thinking before acting;

* Concern for others – genuine compassion for another’s suffering, sometimes ahead of our own concerns for our self;

* Problems solving abilities – experienced as therapeutic when patients experience us willing to be helpful, having their back.

Ron explores how the insight of the Buddhist tradition into impermanence, suffering, and no self can lead to wise therapy.

* Expecting and embracing change is a necessary aspect of the therapist to be able to help patients stay open to the changes in their experience and learn to ride the waves of joy and disappointment, success and failure.

* The evolution of the human brain has made us vulnerable to suffering:

The human brain tends to habituate to experience, so that even the best of experiences eventually become unsatisfactory and we want more and more; researchers call this the hedonic treadmill.

We focus more on negative experiences than on positive ones, simply for survival, as individuals and as a species, an innate negativity bias in the brain.

When our brain isn’t focused on a specific task, the brain goes into its “default network,” ruminating more about the past or future rather than just “being” in the moment.

Mindfulness practice helps us see clearly all of these hard-wired in habits of the brain, and helps us choose to change or let go of our habitual responses to experience.

* The Buddhist view of no self is at heart an ecological view – noticing that with every bit of food, every breath, and every movement, the organized “I” that I think of as “me” reveals itself to be part of the web of life, which in turn is part of the web of matter and energy that makes up the universe. Ultimately we find that the world is not populated by organisms or “things” at all, but only by processes in constant flux.

This view has important implications for psychotherapy. First, it allows us to open to and bear more of our experience.  By not getting so caught in thoughts about “me” and “you,” it is possible to bear emotions at much higher levels and to allow waves of emotions to pass more freely. This shift allows the therapist to embrace stronger and stronger emotions and thereby better accompany their patients wherever they need to go.  It enables everyone in the room to open more fully to all feelings (including shadow aspects of ourselves) as passing, impersonal phenomena.

Ron concludes the chapter with identifying core healing principles regardless of orientation:

Much of suffering is rooted in avoiding our experience or pursuing experience and tripping on the hedonic treadmill.  We open to healing when we encourage experiences of flow – we’re fully involved in whatever we’re doing with minimal self-consciousness or concern about our performance, and when we encourage engagement with life, moments of savoring, and gratitude and generosity.

In Chapter 12, “The Wisdom of Connection,” scholars-therapists Judith Jordan and Janet Surrey describe the benefits of mindfulness and compassion-based relational-cultural therapy. (RCT)  Because our bodies and brains are evolutionarily hardwired to connect, our nervous systems are primed to function best when we experience a sense of “we,” of connection.  Being in relationships brings comfort, reduces stress, and creates positive changes in the brain.  We need relationships to thrive, indeed even to survive.

The authors directly challenge the mis-match of our biology with the prevailing paradigm of Western culture that privileges autonomy and focuses on the individual as the locus of change and growth.  They see the culture’s over-emphasis on self-development and protection creating difficulties in living in mutually empathic, safely vulnerable, authentic relationships.  And that competitive “power-over” strategies skews the experience of self toward the chronic and painful sense of failure, deficiency, disconnection, isolation, and fragility of self worth so prevalent in Western societies (and in therapy sessions).  Even though we are neurologically primed to connect with others throughout our lifespan, we find ourselves in a culture that eschews dependency, connectedness, and emotional responsive.  Messages abound that we must be strong in separation, stand aside from our feelings, and function in a competitive way.

RCT sees interconnectedness as the natural state of human beings, places relationships at the heart of healing, and uses the wisdom of connection to create healthy experiences of self and other.  It uses meditative practices from meditation teacher Thich Nhat Hanh to nourish love, honesty, harmony and compassion to support an individual’s participation in relationship and communities. “Happiness is not an individual matter.”  (Nor is wisdom)

RCT also uses an Insight Dialogue co-meditation practice where therapist and patient speak and listen as co-meditators.  Contemplations are designed to incline the mind toward wisdom, and the practice develops shared insight into non-separation and seeing through self-images and constructions.  Strategies of disconnection are seen and released and experiences of “being with” and “seeing with” are cultivated. Perhaps even more than intrapersonal meditation, it offers the relational therapist and clients the deep wisdom co-arising from profound moments of insight into the suffering of separation and the potential for wisdom in connection.

The authors cite research with meditators that shows that the part of the brain that keeps track of what is “self” and what is “other” is less active in experienced meditators, and it gets quite still during compassion meditation.  Researchers in Germany have suggested that clients of therapists who meditate do better in therapy than clients of non-meditating therapists.  Being empathically present with clients creates a sense of safety and brings about healing – fruits of relationship wisdom.

The therapist works with transparency, when a client can see and feel that he or she has had an effect on the therapist, the clients begins to feel that he or she matters.  This heals the suffering of separation, the fear of being unlovable, being alone.

The therapist also lets go of defensive conceptualizing shifting from narrative to here and now experiential processing.  As poet John Keats suggests we “stay in uncertainty, mystery and doubt without irritable reaching after face and reason.”The therapist encourages small steps, small risks in relinquishing the illusion of isolation and moving toward a felt sense of connectedness.  Through this process, clients begin to trust their capacity to assess the safety and growth potential of relationships.

Staying empathically present with the suffering of clients if the core of treatment in RCT, leading to five good things: 1) an increase in a sense of zest; 2) knowledge of self, other, and relationships (clarity) 3) increased sense of worth; 4) productivity/creativity; and 5) a desire for more connection.

Responding to the pain of disconnection is the practice of compassion, and viewing our suffering through the lens of interconnection is the practice of wisdom. J.J. and J.S.

Jack Engler and Paul Fulton, scholars at the Barre Institute for Buddhist Studies, among other things, begin Chapter 13 “Self and No-Self in Psychotherapy” with:

“Modern psychotherapists use ancient concepts from Buddhist psychology selectively, naturally favoring those most compatible with our models of health and pathology and omitting others.  The most vexing point of departure between these two healing traditions is the nature of self.  According to Buddhist psychology, the self that we treasure and protect is significantly less substantial than it appears, and mistaking it as “real” is a major source of psychological suffering.  Instead, our sense of self arises when conditions support it and disappears when conditions do not.  The self has no enduring essence that stands apart from, or behind, experience – no consistent “me” to whom all experience happens.  Therefore, from the Buddhist perspective, our fundamental reality is better described as “no-self,” or in Pail, annata.

[My own need to reconcile the strengthening of the personal self I offered as a psychotherapist with the profound ease and freedom from suffering I experienced from the no-self fruits of meditation also fueled, in large part, the writing of Bouncing Back.  Chapter 19: The Wisdom of Simply Being, is my reconciliation.]

“Although no-self is a relatively new concept in modern psychology and psychotherapy, understanding this idea, especially from firsthand experience, has great potential for alleviating suffering.  For Buddhist meditation practitioners, discovering the evanescent nature of the self is the essence of wisdom, and it is accompanied by a profound sense of contentment and well-being.  It seems natural, therefore, to consider how the concept of no-self may inform the theory and practice of psychotherapy.”

The authors then explore the nature of “self” in psychotherapy and in Buddhist practice.

In the West, the self is commonly understood as a natural developmental accomplishment dependent on adequate emotional nourishment in early life and ongoing interaction in the social world.  In the ideal, healthy, mature individual, the self is viewed as relatively autonomous, independent, separate, and stable.

No-self, anatta, is any moment of experience that is not organized around the representation of self as a separate, independently existing entity – any time I am not organizing myself as “me” or “mine,” or as any representation or identity at all.  In fact, anatta is an actual experience we have all the time; hearing one’s name called and responding without a second thought; the ecstasy of a child staying on his or her bike for the first time; losing one’s self in the contemplation of a work of art; a pianist completely absorbed in the music, playing unself-consciously; a therapist listening in complete attunement with a patient.  All of these experiences have at their core a feeling of being completely at one with what we are doing. Awareness is nondual.  There is just the activity and the awareness of it; the knower and the known are experienced as one.   When we think of anatta this way, we can immediately recall many such moments in which consideration of self is absent.  When we reflect on them, we notice that they are actually our best moments – the times when we felt freest, most in tune with ourselves. Most in a flow with our experience, least anxious and conflicted, most spontaneous and creative.  In those no-self moments, we tend to function more efficiently and wisely, with natural and spontaneous curiosity, compassion, and joy.

Buddhist psychology identifies the persistent illusion of a separate, enduring self as a primary source of psychological distress.  With even a modest degree of introspection, we can see how much of our inner lives are concerned with ourselves: nearly constant defensive maneuvering, efforts to maximize our self-esteem, or the incessant tendency to compare ourselves with others.  We invite a subtle valuation of experience as good for me, or bad for me.  Our likes and dislikes become de facto yardsticks by which all experience is judged, resulting in a degree of restlessness.  We come to feel vaguely separate.

As a system of healing, then, Buddhist practices do not seek to relieve suffering by improving self-esteem or rewriting personal narratives in a more self-enhancing manner.  Rather, they seek to illuminate the self’s ultimate ephermerality, and how our restless grasping for pleasure and avoidance of pain reinforce this illusion and give rise to unhappiness.  Like a kitchen appliance running in the background, we may only notice this activity once it stops, however briefly.  In these moments we can feel enormous relief; life becomes less complicated, and we begin to learn to rest in our experience without constant clinging to our complaints or opinions.

With that foundation, the authors brilliantly apply the vocabulary of Western psychology – object relations, perception, defenses – to a continuum of self to no-self, moving from egocentrism to a broader, less personal perspective.  The treatment model they suggest that best evokes the liberating experience of no-self is Richard Schwartz’s Internal Family Systems (IFS).  (See Resources below; sorry, no e-newsletter yet!)

IFS starts from the observation that we have an internal family system that is composed of “parts” in complex and dynamic relationships with each other, very much like members of our external family.  This means that the self, from the outset, is not a singular entity, a view shared by Buddhist psychology.  The first challenge is to recognize these multiple aspects of myself as just parts – not who I essentially am.  Normally we are identified with limited parts of ourselves and we take them to be who we are.  The second challenge is to unblend from them.  When I unblend, I am instantly in some degree of no-self or anatta and have less need to protect an illusory sense of self.  The third challenge is to work with these parts to help them find constructive and preferred roles – ways to live and work in harmony.

Dick Schwartz actually used Self to refer to the unblended state.  It denotes the same reality asanatta or no-self in Buddhist thought: a state that is not motivated by, or organized around, a sense of a separate, inherently existing agentic self. Working with one’s inner “parts” in IFS is similar to Assagioli’s sub-personalities or Jung’s complexes.  We instinctively know this multiplicity of mind when we say, “A part of me wanted to do it, but another part of me didn’t.”

The Self or the perspective of no-self can engage with and communicate with these parts that simply want to be seen and heard when the awareness and approach of the Self has no pre-conceptions or judgments, not wanting to fix, change, repress or get rid of that part.

It is possible to listen, acknowledge, appreciate the efforts of these parts on behalf of our survival and well-being.  Even parts that are in despair, mean, stubborn, selfish, self-critical have a specific role and function to play – to protect us from hurt or disappointment, to manage some situation in our internal or external life.  The Self discovers the intentions of these parts, experientially not conceptually, through the compassionate curiosity and the full acceptance of the no-self, where there is nothing to defend or promote.  As the Self (no-self perspective) inquiries into the roles and functions of these parts it might find objectionable or intimidating at first, it always eventually finds the benign intent of the part, similar to the wisdom of the poet Rumi’s Guest House:

The dark thought, the shame, the malice,

meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

The Self welcomes every part and learns to work with it well as a conductor learns to work with every instrument of his orchestra. The Self can mindfully step back (unblend) and engage with each part in wise and compassionate dialogue, appreciate its efforts for the good of the whole.  Rather than get rid of, extinguish or transcend a part as unwholesome, or replace it with something more wholesome, the Self provides the psychological leadership to transform and integrate these parts into more positive wholesome roles.   The Self rests in awareness of all of the parts, observing, dialoguing, appreciating with no judgment or agenda. In its realization of being no-thing in particular, it realizes and abides in its own wholeness.

The authors cite Schwartz’s eight wholesome qualities of this wholeness: calmness, clarity, curiosity, compassion, confidence, courage, creativity, and connectedness. [Very similar to the 5 C’s of coping identified independently on my own journey in Bouncing Back.]  These qualities and others cited in both IFS and Buddhist practice – joy, humor, acceptance, forgiveness, and gratitude – are naturally experienced when we rest in the awareness that makes all of these experiences possible.  This nondual, selfless awareness lies at the root of all awakening and truly wise action in both internal family systems and in Buddhist practice.

Chapter 14: “The Neurobiological Foundations of Wisdom”

Given that understanding wisdom is an ancient and multifaceted quest, and given that the brain is the most biologically complex entity known to man, and given that the technology of neuroscience is so blink-of-an-eye recent, probing the neurobiology of wisdom is a daunting, if intriguing, task.

The authors of this chapter, researchers Thomas Meeks, B. Rael Cahn, and Dilip Jeste have approached this conundrum in two ways: researching the neurobiogical foundations of six components of wisdom, (see below) and researching meditative states and traits of consciousness.  The findings of this research reveal some overlap in increased use of regions of the brain common to both – the pre-frontal cortex [identified as the CEO of resilience inBouncing Back] the anterior cingulate cortex (the structure we use to focus attention and detect mistakes) of the “higher brain”, and the limbic striatum  of the “lower brain,” suggesting a balance between these areas seems to underlie wisdom.

Prosocial Attitudes/Behaviors

Neuroscientists have studied the impact of empathy, compassion, altruism, and social cooperation on the brain, considering them attitudes/behaviors that serve the common good.

The mirror neuron system of the pre-frontal cortex comes into play in empathy, activating when we both perform an action and observe someone else performing the same action, or when we experience an emotion and observe another experiencing that same emotion.  High-amplitude gamma wave activity has been measured in practitioners of compassion meditation, reflecting a highly attentive brain state. Areas of the brain involved in perspective taking – the right temporal-parietal-junction are also activated during compassion meditation.

Altruism and social cooperation seem to “light up” the primitive reward neurocircuitry of the brain – the nucleus accumbens/ventral striatim – as well as the pre-frontal cortex.  (This chapter includes diagrams that illustrate the location of these structures in the brain.)

Social Decision Making/ Pragmatic Life Knowledge

Neuroscientists have researched brain activity during tasks of “mentalizing – understanding the inner world of others – that could contribute to our social decision making.  The medial pre-frontal cortex is highly involved (and the structure of the brain that allows us to attune to and have empathy for our own experience as well as the experience of others) as well as the structures that help us read the social cues of others – their body gestures or facial expressions (the posterior superious temporal sulcus) and that distinguish between the perspective of self and other – the temporal parietal junction.  Meditation strengthens all of these functions.

Investigation into moral decision making indicates that the dorsal lateral pre-frontal cortex is recruited to use more calculated and rational thought processes to overcome more automatic emotional responses. And that resolving moral decisions that include a conflict between emotional and rational decision making requires the use of the anterior cingulate cortex which could detect that inner conflict.

Emotional Homeostasis

Researchers have studied impulse control as part of emotional regulation, returning to homeostasis or balance in the nervous system.

Again the anterior cingulate cortex detects conflict between instinctual emotional responses and more cognitive rational social responses.  The lateral pre-frontal cortex can maintain more socially advantageous responses in working memory and choose appropriate actions or inhibit inappropriate reactions.

A key neurobiological factor in emotional homeostasis is the ability of the pre-frontal cortex to inhibit limbic reactivity. (The negativity bias and survival responses of the lower brain.)  One key way this happens is by labeling emotions with words, the “notice and name” of mindfulness practice.  Noticing and naming increases activity in the pre-frontal cortex, and decreases it in the amygdale. “Use your words” has real power.

Reflection/Self-Understanding

The medial pre-frontal cortex is involved in cohering a stable sense of self, a sense of continuous autobiographical memory.  When not focused on a particular cognitive task or emotional stimulus, this part of the brain can “default” into a “default network” that is still self-referential in the sense of focusing, sometimes ruminating, on the past or the future in a way that can become self-absorbed.  Neuroscientists have discovered that even relatively brief training in mindfulness quiets the activity of this default network ( the natural state of the brain when it’s not focused  on a specific task) leading to a kind of self-reflection of “being” rather than “doing.”  Healthy self-reflection rather than ruminative self-denigration can help loosen the grip or the identification with the self at all.

Value Relativism/Tolerance

“Acceptance that the world consists of diverse people with different beliefs and value systems, without judging them as “right” and “wrong” (value relativism) has traditionally been considered an important component of wisdom.  Beyond believing in this abstract concept, tolerance requires the considerably more difficult task of acting on it.  This may not be a universal goal of psychotherapy, though one might argue that such tolerance is a basic component of health.  And even if not taught directly, many therapists cultivate it in their clients through modeling – by accepting all that the client “brings to the table.”

It seems that the same impulse control function of the pre-frontal cortex is involved in deactivating the survival responses of  the amygdala when prejudices or judgments of “wrong” or “different” begin to surface. The capacities of the pre-frontal cortex to mentalize another person’s point of view may also help us move beyond an excessive focus on one’s self.

Dealing Effectively with Uncertainty/Ambiguity

Various parts of the pre-frontal cortex are activated when we are faced with either risk or ambiguity but the biological studies haven’t kept up with clinical interest in this factor of wisdom yet.  Stay tuned.

More and more studies indicate, daily, that meditation techniques actively produce neurobiological outcomes that strengthen the elements of wisdom identified in this chapter.  Therapy can be used with great efficacy to create lasting and positive changes in brain function and structure that can strengthen the path to deeper wisdom.

Part IV Clinical Applications

Because as many readers of this e-newsletter are not clinicians as are, and  because I don’t want this e-newsletter to turn into a book itself, I’m going to give the 6-minute version of the TED talk in this section, rather than the full 20 minutes.  Every chapter is still a gem, and worth perusing in more detail.

Chapter 15 “Compassion, Wisdom, and Suicidal Clients”

Marsha Linehan, developer of Dialectical Behavioral Therapy (DBT) and her doctoral student Anita  Lungu explore how radical acceptance (compassion) plus real guidance (wisdom) are necessary to help suicidal patients build a life worth living. [Implementing the principles of DBT has helped me help suicidal clients choose to live rather than die more than once.  Deep bows to the effectiveness of this modality of treatment.]

One of the assumptions in DBT is that the lives of suicidal individuals are unbearable as they are currently being lived.  DBT’s ultimate goal is to help people find a way through excruciating emotional pain and back to life.  Compassion is what allows patient and therapist alike to tolerate the emotional roller-coaster of suicidality and simultaneously offer concrete help in changing current behaviors patterns and circumstances.

The dialectic is to balance radical acceptance of what is (and compassion for the pain of that) with tools for change (fostering hope in the midst of hopelessness for a better life).  Accepting and tolerating intense painful moments and also changing painful circumstances have to be brought together in a coherent balance. The therapist can’t control but can’t let go either.

DBT is an integration of behavioral therapy with Zen meditation practices. Both Zen and behavioral therapy emphasize verbs, action, process, flow, more than nouns or self.  Both teach the inter-connectedness between an individual and its environment, even all of existence.  The individual is not lost in either Zen or behavioral therapy.  To say the wave is the ocean is not saying there is no wave.  Both emphasize moving toward and embracing experience rather than avoiding unpleasant or intolerable experiences, regulating the emotions and tolerating the distress of them.  Rather than avoiding being angry, which only causes it to persist, the patient is taught to act as though they are already compassionate and the anger will subside in the presence of the compassion.

Mindfulness is the cornerstone of DBT, helping patients observe, describe, participate non-judgmentally and skillfully in the experience, fully access their own inner wisdom, their own wise mind that embraces emotional, rational, intuitive, and spiritual modes of knowing.

Acceptance is also key – to observe, open to, tolerate, and eventually embrace all that life is presenting in the present moment.  DBT requires a spacious mind, an open heart, and the strengthen to bear one’s experiences.  The therapist must radically accept the fear and hopelessness of the patient, the trauma and losses of the patient’s past, validating the importance of what has happened or is being experienced now, while holding out the possibility of change.

In Chapter 16:  “Substance Abuse and Relapse Prevention,” G. Alan Marlatt, Sarah Bowen, and Kathleen Lustyk, pioneers in mindfulness-based relapse prevention, reframe substance abuse treatment as learning to make wise choices through careful observation of one’s own experience without shame and self-blame.

Researchers have discovered that any substance can hijack the brain’s neural circuitry of pleasure and reward (involving the lower brain’s ventral tengmental  area and the nucleus accumbens) and the pre-frontal cortex.  The substance of choice actives the release of dopamine in this pleasure and reward circuit, which makes the person feel very good.  Over time, this pleasure circuit is less and less activated by the substance, requiring more use (abuse) to achieve the same “high.”  When the dopamine levels fall too low, the person experiences pain rather than pleasure, which triggers another round of substance use (abuse) which lead to physical and psychological addiction.

Compassionate acceptance opens the door to treatment; mindfulness offers a meta-cognitive strategy for relapse prevention.  Patients stop blaming and hating themselves for their “bad” behavior, a judgment that will often trigger another round of substance abuse. Mindfulness opens the door to recognizing the cravings, “surfing the urge” – holding it in compassionate awareness without trying to fix it or make it go away – until it passes on its own; learning new strategies and attitudes to cope more resiliently with the inevitable ups and downs of life because the tai is no longer wagging the dog.

Mindfulness Based Relapse Prevention (MBRP) integrates relapse prevention with mindfulness based cognitive therapy in a harm-reduction model of treatment to develop awareness of environmental triggers and internal reactions.  “What is actually happening? And “What does my mind do with what is happening?” By learning to differentiate between what arises (a physical sensation or an emotion) from how we relate to it (with judgment, aversion, clinging), we develop flexibility – whatever arises we have a choice in how we respond.  By bringing non-judgmental, compassionate awareness to this process, clients learn to observe the habits of the mind and to discern between observing and responding vs. habitually reacting.

Mindfulness is especially helpful in relapse prevention, because it strengthens the very structure of the brain most impacted by substance abuse, the pre-frontal cortex.  Since mindfulness practice does grow new cell structure in the pre-frontal cortex, it strengthens the executive functioning of that structure, including activating the release of the inhibitory transmitter GABA to quell the surges of impulses associated with addiction.  (Had a bad day?  Have a drink.  Stressed at work? step outside for a smoke.) When mindfulness brings those automatic reflexive coping patterns to awareness, the pre-frontal cortex can act to inhibit them.

MBRP  isn’t about eliminating all triggers, cravings and challenging mood states that lead to addictive behaviors. It is about increasing the compassionate awareness that expand our choices in how we respond to those triggers and challenges.

In Chapter 17: “Anxiety Disorders: Acceptance, Compassion, and Wisdom,” researchers Lizabeth Roemer and Susan Orsillo, co-authors of The Mindful Way through Anxiety, have developed an Acceptance-Based Behavioral Therapy (ABBT) to address the universally human struggles with fear and anxiety.  Similar to other acceptance-based therapies (A.C.T. MBCT, DBT) they use mindfulness to help clients see their own patterns of fueling, judging  or avoiding their anxiety, cultivate compassion and a genuinely kind and accepting stance toward themselves and their experiences, and choose new more skillful responses based on new learning and wisdom.

There are life experiences, some of which we interpret as symptoms, and then there are our reactions to those experiences and symptoms.  How we relate to any initial sign of fear or anxiety can determine whether that fear or anxiety remains a useful signal to take action in the face of danger or threat, or becomes itself a chronic experience of distress and struggle, judging our situation as catastrophic or ourselves as weak.  The anxiety itself becomes threatening and derailing of our resilience and life satisfaction.

One response to anxiety is to try and avoid it, to deny, distract, or transcend (flight into light).  Experiential avoidance has been shown to increase the frequency and intensity of symptoms of anxiety, not reduce them, feeding the cycle of distress rather than ending it.  Experiential avoidance, and the resulting behavioral avoidance, interferes with the healing resolution to the anxiety – becoming mindfully, compassionately aware of experience in the present moment so that new learning, new choices, new possibilities, new solutions can be revealed.

AABT proposes a model of treatment that includes:

Psycho-education about the nature of anxiety and worry, so that patients begin to see their experiences as natural and understandable rather than frightening and dangerous, and relate to their symptoms with compassion and care rather than seeing them as a sign of weakness or inability. Patients begin to understand that the emotions themselves are not the problem but that reactivity to these emotion , or efforts to avoid them, are what lead to difficulties.  They also help patients distinguish between clear emotions -a direct response to a current situation – and muddy emotions – leftover response to past situations or anticipated of future threats or judgments about our emotions.

De-centering: as patients notice and record their experiences through the day, they begin to observe them rather than remaining entangled or fused with them.  De-centering allows the patient to experience their experiences as experience rather than defining who they are.

Mindfulness: clients cultivate a new relationship with their internal experience  Mindfulness helps patients see how judgments automatically color our reactions to neutral events. (“That sound is screeching brakes – people drive so poorly!”  or “That’s a person laughing – why don’t I ever laugh anymore?”  With mindfulness, noticing how frequently the mind automatically judges even the most benign experiences, we can begin to feel kindness and compassion toward ourselves for this very human habit.   Patients can imagine placing their thoughts on leaves as they float by on a stream, or that their thoughts are clouds and they are the sky behind the clouds to practice this new relationship to thoughts and feelings. Patients often discover that their emotions are less all-consuming that they had  imagined.  They also learn that they can tolerate the distress they have been avoiding for so long.  This acquired wisdom allows them to live their lives more fully.

The therapeutic relationship is a powerful vehicle for changing the relationship patients have with their internal experience.  As the therapist validates the client’s experience and accepts whatever response and reactions the client expresses as part of being human, and models their own moments of compassion for their own experiences, the patient can more easily actively and intentionally cultivate self-compassion for themselves.

Experiential acceptance rather than experiential avoidance helps patients notice the tendencies of emotions before they become full blown actions.  A patient who fears his anger will cause him to yell and punch walls as his father had can allow this feelings of anger to safely arise, compassionately hold them in mindful awareness, and as he becomes familiar with the tendencies of his own experiences, not wallowing in them beyond their usefulness, choose alternative ways to express his anger without harming.

Living a Life that Matters:  Therapists can help patients clarify and act on behalf of goals that are meaningful, in spite of the reactivity of their internal experiences, including the practice of self-compassion to accept their internal experiences and wisdom to guide new behaviors.

Chapter 18: Depression: Suffering in the Flow of Life

Although depression can take many different forms and vary in severity, chronicity, and age of onset, its symptoms are all too familiar.  They include a loss of motivation, the inability to experience pleasure, and a sense of being wrapped in a cloud of hopelessness and pessimism.  One feels physically tired, on edge, racked with feelings of dread, permeated by a sense of being inadequate.

In this chapter, Paul Gilbert, author of The Compassionate Mind, applies his Compassion-Focused Therapy (CFT) specifically to depression.  [See the January 2013 e-newsletter The Compassionate Mind for a fuller description of CFT.]

He begins with a shift to an evolutionary perspective – that we evolved as a species in the ongoing flow of life.  Because of our genetic endowment, our brains and bodies can detect and react to threats with alarm, anxiety, or anger; to good things with pleasure; and to setbacks with disappointment and a dip in mood.  So, as in many other animals, anger and aggression can flare up when we’re faced with conflicts and obstacles; anxiety can cause flight and avoidance when dangers arise; and the loss of positive feelings and abilities to engage in the world (depression) can pattern our minds when we are confronted by major losses and stresses we feel unable to control.  Depression is the brain’s way of defensively shutting down under conditions of adversity to maintain attention on threats and losses.  As a basic defensive strategy, the capacity for depression long preceded the emergence of humanity.

We can understand that much of what goes on in our minds – the urgency of our desires, the power of our emotions, and the depth of our moods – is not of our personal design nor of our choosing and therefore is not our fault.  Depression is something we would never chose, and it is only made possible because evolution has designed it within us as a potential strategy.  When people struggling with depression really understand the evolution of mind, and why depression is not their fault, it can help cut through the deep-rooted shame and self-criticism associated with feelings of weakness, inadequacy or worthlessness.    These dark states arise because depression often carries with it the feeling that there’s something wrong with ourselves – we are failures, inadequate losers, unwanted, trapped in pain, and a burden to others.  Within our own head we will be self-critical or even self-loathing rather than self-compassionate.  Under these conditions we can easily slip into depressed states.

Compassion can emerge from the insight that we are all caught up in the flow of life with brains that we didn’t’ choose and that are capable of some very painful mental states.  This is absolutely not our fault – we’re hardwired to feel bad at times.

Wisdom can also develop from the insight that we’re part of an evolutionary process; we are creatures with inbuilt programming and social conditioning.  Each of us could be different versions of ourselves had we grown in different environments.

Viewing depression as a brain state, Gilbert proposes three emotion regulation systems of the lower brain we need to know how to work with to antidote depression.

The Threat System

The most basic system, “our factory setting,” so to speak, is our threat system, whose purpose is to protect us.  With various modifications, we can plot its basic design and structures back through evolutionary time, recognizing similar brain mechanisms for dealing with threats in the rat, rabbit, and monkey.  One of the major areas of this system is the amygdala, which responds very rapidly to signals indicating threat or disappointment – often before conscious thinking arises.  The threat system can bias and focus attention, activate defensive emotions and generate defensive behaviors.  We detect and respond to threats more easily than we remember positive ones.

It is the threat system that is typically involved in mental health difficulties, and depressed people have elevated sensitivities here.  Early frightening experiences, particularly those related to abuse, can have a permanent impact on threat processing systems, with increased risk of depression later in life.  We also know that depression is linked to rumination on threat-focused themes that constantly stimulate the threat system.  So, a combination of genes and early learning has given us a brain that, through no fault of our own, is highly focused on possible threat and easily stressed and depressed.

The Drive and Achievement System

The drive system is especially linked to dopamine and can be triggered by anticipation of, or actual, rewards.  It seems Western society seriously over-stimulates this dopaminergic system with its constant focus on needing to achieve and own more and more, media that glorifies celebrity, and materialistic, competitive computer games – all leading to increased stress and exhaustion.  Western society appears to be promoting extrinsic goals of self-promotion, self-fulfillment, and achievement at the expense of intrinsic goals of cooperation and community building, with clear indications of deteriorating mental health consequences in the last 30 years.

Depression becomes more serious when individuals identify with the state and see themselves as worthless, personally inadequate, or failures.  It is one thing to feel one has failed in a situation but quite another to see oneself as a failure.  The state may unlock memories of feeling defeated or powerless, perhaps from abuse or being labeled as inadequate, useless, or bad.

The Contentment, Safeness, and Affiliation System

The contentment system is subjectively quite different than the drive system.  It gives rise to positive emotions associated with well-being, peacefulness, and calmness.  The neurochemistry of this system is linked to neuropeptides, especially oxytocin and the endorphins.  There is now good evidence that oxytocin facilitates attachment behavior and opens individuals to trusting, affiliative possibilities.  Recent research has shown that the endorphin and oxytociun systems, which seem to underpin feelings of contentment, safeness, and well-being, were adapted during the evolution of mammalian attachment and social affiliation.  In fact, feeling loved, cared for, and supported is probably one of our most important sources of contentment and well-being.

In addition, these social affiliative experiences can lay a fundamental role in regulating our sense of threat. When an infant, child, or adult is distressed, physical affection (in voice tones and with holding and cuddling) stimulates the oxytocin and endorphin system, calming distress.  Repeated throughout childhood, this process of affection leading to calm stimulates the growth of the neurophysiological pathways that have major effects on our ability to regulate emotions and moods and to develop a positive sense of self that does not collapse under the weight of setbacks or failure.  Affiliative experiences may exert their powerful effect on threat and stress states through oxytocin receptors in the amygdala, which down-regulate threat responses.  The same is true for self-kindness, in contract to self-criticism or self-hatred.

The endorphin-oxytocin system, associated with feelings of well-being and connectedness that help us feel safe may also underpin feelings of bliss and connectedness associated with meditative or transcendental states. So from the day we are born to the day we die the kindness of others will have major physiological impacts on our brains and bodies.

Depression

A biological view of how the mind evolved and how the nervous system functions allows us to become wise – to see our mental processes in perspective – when we are depressed.  A depressed brain state includes a human capacity for rumination, pessimistic projection into the future, and self-judgment.  These processes constantly activate the threat system by holding in mind stressful events or engaging in self-critical and self-deprecating evaluations.  Our self-aware mind can activate, maintain, and even accentuate and amplify the basic defenses of anxiety, anger and/or depression.

Looking at depression in terms of our three affect regulation systems, we know that depressed people have increased threat processing – they are more prone to experience anxiety, anger, irritability, and dread – and reductions in the two types of positive affect.  When the drive system is toned down, we may experience an inner deadening, a loss of motivation, and decreased ability to enjoy, look forward to, or feel excited about things.  Food, sex, and holidays can seem pointless or just too much effort.  The world is gray, black, and lifeless.  When in a deep depression, we can feel full of dread, regretting each morning we wake up.  We may feel like inadequate, defeated failures.

When the soothing and affiliative systems are toned down, we experience ourselves as cut off from others, disconnected, alone, isolated, unloved, and unwanted.  It is difficult to feel affection or understanding.  It is as though there’s a kind of barrier between us and others.

The potential for depressed brain states has been built into us via evolution.  That is not our fault – and by becoming compassionately mindful of this blamelessness, we can learn to not identify with these states of mind.  It’s like water that can be dyed blue, yellow, or green – the water is not the color.  So it is with depressed brain states, with all of the bodily feelings and self-evaluative systems that are part of it.  These can be separated from the essence of the self – the experience can be separated from the experiencer.

Compassion Focused Therapy is rooted in evolved attachment and affiliative processes whereby a compassionate “other” can provide a safe base for soothing and calming the threat and distress response (as  mother might provide for her child) and that facilitate exploration and engagement with both th outer world and the inner world of feelings.  Similarly, creating an inner compassionate sense of self cancreate a safe base for working on painful feelings and memories.

CFT uses compassionate imagery and focused attention to create an inner “safe base” that links to the soothing system, helps us engage difficult feelings, and mentalize about them.  The patient is taught to imagine a compassionate self, a perspective that is quite different than the angry self or the anxious self.  The patient is taught to imagine compassion flowing into the self from others, flowing out from the self to others, flowing from ourselves to ourselves, even to parts of ourselves.  This latter exercise is key in shifting from self-criticism, even self-hatred so common in depression, to self-understanding and self-compassion.  One first evokes the compassionate self, then imagines that compassionate self saying, “(your name) may you be happy; (your name) may you be free from suffering, (your name) may your flourish.”

Mindfulness safely anchors awareness, loving kindness practice creates the courage and support for compassion to engage what is frightening or overwhelming and offer it soothing and care.  Compassion heals, and changes the functioning of the brain as it does so.

In Chapter 19: “Working with Trauma: Mindfulness and Compassion,” psychologist John Briere explores the role of compassion, as ancient in human experience as trauma itself – in healing trauma and shows therapists how to accompany and guide those who have endured extreme suffering.

Trauma – adverse events that harm or de-stabilize a person – activates biological systems associating with survival, produces great anxiety, and usually narrows awareness to immediate survival.  Memories are formed, carrying with them emotions, cognitions, and sensations that become associated with the trauma and that can be triggered and relived as flashbacks, intrusive thoughts, painful feelings, and other aspects of post-traumatic stress. In some cases, these memories may be continuously activated, leading to chronic anxiety, depression, or anger.  Trauma can also breach the assumptions most of us carry about ourselves, our safety, the future, and sometimes the goodness of other people.  Finally, trauma can involve existential confrontation, leaving the affected person feeling entirely alone, irrevocably changed, and flooded with awareness of the fragility of life and well-being.  Face with overwhelming experience, many trauma survivors are understandably motivated to avid thoughts, feelings, and memoires about what happened to them.

Compassion – unconditional caring, attunement, and acceptance of the suffering of the client, grounded in mindfulness, with the felt desire to relieve that suffering – is essential for the healing of trauma, for the trauma survivor to fully engage his or her history and pain, while, at the same time, appreciating his or her own innate value and abilities.

With compassion supporting any form of trauma treatment, the therapist’s visible, sustained, noncontingent caring 1) engages the client’s inborn attachment system, which is sensitive to, and triggered by, loving attention from important relational figures and 2) activates biological self-soothing circuitry that down-regulates the activity of the threat recognition system.  The compassion clinician becomes the antithesis of, if not the antidote to, the client’s initial traumatization,  providing  input for changes in the survivor’s perception and response systems.  As the therapist conveys by behavior and words his or her unconditional positive regard and caring, the survivor has the opportunity to undergo trauma-disparate experiences that gradually undercut negative conclusions about him- or herself associated with victimization.  The therapist’s visible non-contingent acceptance of the client as a person, entitled to happiness and well-being and the client’s therapist-supported integration of especially overwhelming and potentially stigmatizing traumatic recollection of  the stigmatizing traumatic material into “mere” or “just” painful memory reduces the stigma and personal badness associated with trauma memory.  Such recollections slowly lose their power to shame and motivate avoidance, thereby facilitating further processing and integration.

Briere points out that compassion indirectly benefits the therapist as well, allowing him or her to be exposed to considerable pain and suffering without being disarmed, distracted, or personally activated.  And mindfulness grows the ability to observe and reflect upon one’s thoughts and feelings and to learn that such internal processes are, most immediately, products of the mind and not necessarily evidence about the true state of reality.  Mindfulness allows the therapist to perceive and respond to the client in a more attuned and non-reactive way, producing many of th4 requirements of an optimal therapeutic relationship.

In Chapter 20: “The Heart of Couple Therapy,” couple therapists Richard Borofsky and Antra Borofsky explore how therapists can help their clients grow in love by safely experiencing their vulnerabilities and by sharing the depth of human experience -sorrows, fears, and joys – with one another.

Intimate couple relationships awaken us to both the fullness and the difficulty of loving one another.  On the one hand, love illuminates and animates the best in us.  Through love, we are able to enlarge the span of our compassion and caring, and to deepen our faith in our own and each other’s essential goodness.  Together, we are able to find fulfillment simply in our being present and find the courage to face our future, whatever it may bring.

On the other hand, intimate relationships reveal everything that limits our capacity to love and be loved.  These limitations are often the result of painful experiences with significant others, – partners, parents, siblings – which have left unhealed emotional injuries.  Painful disconnections, collisions of differences imbalances of power, and experiences of emotional deprivation, shaming, abandonment, violation, and betrayal are among the many wound experiences that may be evoked in intimate relationships.

Compassion is necessary for couples to share their vulnerabilities – to talk and listen to each other – so they can manage their vulnerabilities together.  The authors quote an old Jewish proverb, “A sorrow kept to oneself is doubled.  A sorrow that is shared is halved.”

Vulnerability naturally gives rise to a relational need, a need to be helped or attended to by ourselves or another in some way.  Compassion happens because vulnerabilities are at the deepest level a call for connection. The openhearted sharing of vulnerability and need is one of the principal ways that love is renewed and sustained.

Feeling that one’s partner is able to accept and hold one’s deepest vulnerabilities creates a profound experience of safety and connection.  This in turn makes it possible to unlock a couple’s repetitive negative patterns of relating as well as neurotic individual patterns – many of which have their origin in relational wounds.  Also, an increase in compassion for one’s partner can often transform one’s resistance to the other into a heartfelt wiliness to help or a willingness to change in ways that the other has wanted for a long time.  Once evoked, compassion is a profound and powerful motivator of change.

This compassion leads to wisdom in the sense of allowing a broader perspective and fuller picture of the partner’s assumptions and expectations, needs and desires, frustrations and hopes.  Compassion and wisdom together increase the empathic concern and perspective taking within the couple, leading to deeper, more intimate emotional exchanges, so they can directly meet each other in the ;moment.

In couple therapy, the authors have each partner talk about their own personal experience, taking responsibility for their perceptions, interpretations, feelings and reactions, reducing defensiveness between them.  They focus attention on the present moment, which makes it more likely that what happens between them will be grounded in their current actuality, rather than being a reaction to memories of past happenings or to generalizations about each other.  When partners focus attention on bodily sensations in the moment, they are experiencing their experience, not merely talking about it, and gaining a felt sense of the other’s experience, not merely hearing about it. When both partners can be more openhearted and undefended, they can begin holding their suffering together.

The authors then describe an exercise where they ask the partners to pass a stone egg back and forth between them, silently at first, creating a non-verbal field of giving and receiving, and then sharing a fear, desire, vulnerability with each pass of the egg.  As the partners receive the egg and the spoken words, they acknowledge their wiliness to listen to this sharing (no commentary, no arguing or fixing).  This exercise in giving and receiving words, feelings, and attention deepens awareness, understanding and acceptance between the partners, and extends the horizon of their humanity, an inclusive wholehearted openness to the human condition that is the hallmark of both compassion and wisdom.

Part V  In and Around the Consultation Room

The co-editors suggest that compassion and wisdom can develop into personality traits – ways of being – with consistent practice over time.  This practice requires that we exercise these virtues not only in therapy but also in daily life.  I’ve reviewed here one of the three TED talks in this section that will land close to home for most readers.

In Chapter 21: “Mindful Parenting as a Path to Wisdom and Compassion,” Trudy Goodman, Susan Kaiser Greenland and Daniel Siegel posit that there is not better training ground for cultivating wisdom and compassion than parenting.    Relentless day and night caregiving responsibilities give rise to a seemingly endless parade of emotional and physical demands and brings parents into a direct relationship with some of the most profound and poignant emotional experiences in life – selfless love, profound attachment, grievous loss.  Parents of young children carry on through exhaustion, stress, and strain, 24 hour a day, 7 days a week, no matter what.  How parents bring a continuity of their own compassion and wisdom to parenting profoundly shapes their children’s ability to know and manage their own emotions, thinking and behavior.

The endless work of laundry, lunches, and little ones calling for attention becomes an opportunity par excellence for training the mind to focus attention with care and compassion.  When the sense of self is under siege – “I’m not good at parenting!”  “I can’t cope!” we practice self-compassion for ourselves -this is painful!…and move into an awareness of our common humanity – I’m not alone.

The authors suggest that parents practice both internal mindfulness, focusing attention on their experience in the moment, and external or interpersonal mindfulness.  If we are mindfully slicing carrots and a child calls for our attention, our awareness can shift from inner personal carrot-focused experience to the external interpersonal environment (attending to the child), and our child’s request simply becomes another expression of the way life is, endlessly changing its shape and appearance.

Wisdom and compassion are applied to parenting as the parents build their own capacity to tolerate discomfort, especially the ever-present anxiety about the child’s safety and well-being.  This means cultivate the capacity to perceive and shift readily from our reactive mode (fight-flight-freeze) to our receptive mode; we stop, breathe, soother ourselves, and  re-open to whatever is happening right now.

It also means healing any problematic memories of how we were treated as children, since the process of raising our children will re-capitulate every stage of our won development. Mindful self-compassion helps us counter-instinctively turn toward our own pain with kindness and compassion so that we can fact it, engage it, and heal it.  We become a “safe other” for our child, creating in them the secure attachment that will become their best buffer against stress, trauma, and pathology.

Wisdom and compassion also foster equanimity in a parent, wading through the muck to find a considered, benevolent response.  It’s all too easy to blame children for pushing out buttons when we don’t know how to turn toward their pain without getting entangled in it.  In the search for perspective, we may move back too far and abandon the child – becoming too detached in a way that leaves him or her feeling all alone.  Or instead we might move in too close, wanting ot fix the pai, smothering the child’s growing capacitors to handle pain on their own. Mindfulness and compassion allow us to pause, feel safe enough to be more mindful, tolerate our own emotional discomfort before acting on it, and reflect on the options with compassionate curiosity.

Mindfulness and compassion also help parents overcome a cycle of perfectionism, expectations, and self-criticism by developing trust in their own “good enough” parenting.  Letting go of “should-ing” and the pressure to be perfect creates a receptive state of mind that allows us to attune more to ourselves and to our children.  Parents can feel freer to appreciate and be grateful for the blessings in their lives.

Parents can tolerate discomfort as they learn to trust the mess, arduous, beautiful path of living with children.  Wisdom will come as parents learn to turn toward discomfort with compassionate curiosity, not taking iton as their own.  We who step onto this path of mindful living stumble and muddle though, learning when to hold on and when to let go.  We trust that things will usually work out – never perfectly – but well enough.  Given sunlight, soil, and water, a plant will find a way to grow.

Poetry and Quotes to Inspire

Whereas acceptance usually refers to what’s happening to us – accepting a feeling or a thought – self-compassion is acceptance of the person to whom it’s happening.  It’s acceptance of ourselves while we’re in pain.
– Christopher Germer

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An upwelling of sadness toward one’s mistakes in life and the cumulative mistakes of all humanity helps serve as a backdrop to the arising of compassion.
– Mu Soeng

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The deepest transformations in therapy arise out of a person’s capacity to hold his or her own inner life with a loving, wise awareness.   This awareness is cultivated by paying attention with unconditional presence: seeing clearly what is – right now- with compassion.
– Tara Brach

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Ultimately, the reason why love and compassion bring the greatest happiness is simply that our nature cherishes them above all else.  The need for love lies at the very foundation of human existence.  It results from the profound interdependence we all share with one another.
– Tenzin Gyatso, the 14th Dalai Lama

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For one human being to love another: that is perhaps the most difficult of all our tasks, the ultimate, the last test and profof, the work for which all other work is but preparation.
– Ranier Maria Rilke

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Love, compassion, and tolerance are necessities, not luxuries.  Without them, humanity cannot survive.
– Tenzin Gyatso, the 14th Dalai Lama

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When you begin to touch your heart or let your heart be touched, you begin to discover that it’s bottomless, that it doesn’t have any resolution, that this heart is huge, vast, and limitless.  You begin to discover how much warmth and gentleness is there, as well as how much space.
– Pema Chodron

Stories to Learn From

[Excerpted from Chapter 7: Cultivating Compassion in Psychotherapy by Christopher Germer]

Maria was the kind of patient I never schedule at 3:00pm when my energy is low.  She was the eldest of seven kids who was entrusted as a young woman with the task of caring for her siblings while her single mother worked in a restaurant.  Long into adulthood, Maria continued to work hard and had few relationships outside her family of origin.  “Superficial” was all I could say about our dreaded meetings.  The more I probed for signs of life, the more Maria retreated.  Yet Maria returned punctually each week, apparently appreciating (or hoping for) an hour of undivided attention.

At some point, I decide to accept the quiet torture of sitting with Maria – accepting it first as my problem, not hers. That simple shift in attention opened up an entirely new world for both Maria and me.

First, I imagined what Maria’s life must feel like if this superficial level of connection was somehow worth her time, money, and effort.  I allowed myself not only to contemplate her experience; I took it in.  Soon I discovered a low feeling in my gut.  Then I touched something in common – loneliness, and how lonely life can sometimes be.  When I emerged from my reverie, I had a newfound sense of kinship with Maria, feeling almost grateful that she was still there in the room, and her words had a tingling sound like little bells in my consciousness.  From then on, I knew where to go – straight into the loneliness – whenever the smokescreen of boredom grew around me. Perhaps Maria could sense my innocent (less therapeutic) curiosity about her, and she gradually brought more of her emotional life into the therapy room.  She started to smile more and delighted in sharing insights she had gleaned about other people and herself through the week.  Learning to cherish Maria, boredom and all, gradually made our interactions anything but boring.

[Excerpted from Chapter 1: Wisdom and Compassion: Two Wings of a Bird by Ronald Siegel and Christopher Germer]

Carmen had suffered from anxiety since she was 9.  She panicked in school during a science presentation and soon after felt nauseous at the mere thought of standing up in front of people.  When Carmen came to therapy at age 27, she and her well-informed parents (who both also suffered from anxiety) had tried every medication and psychotherapy imaginable.  She was virtually housebound due to fear of vomiting, and quite depressed as she watched her friends move forward in their professional and personal lives while she couldn’t even go to the hairdresser.

In a mindfulness-oriented psychotherapy, Carmen discovered that fighting her feelings of nausea simply increased the likelihood that she would vomit in public.  In the office she learned to anchor her attention in the soles of her feet when anticipating a social encounter and to surf the waves of anxiety that coursed through her body.  Nothing worked in real-life social situations, however; every sensation of nausea left Carmen overwhelmed and exhausted.  Anxious genes and a lifetime of conditioning couldn’t be overcome.  Carmen and her therapist agreed that her situation was hopeless…almost.

Carmen began to speak candidly about her struggle with social phobia and panic disorder:  “I’m broken – I’m pathetic!” She and her therapist wondered aloud, might telling someone about her fear of vomiting reverse the shame she felt about her condition?  In desperation, Carmen took a chance and told her hairdresser.  She was amazed at how quickly her fear melted away.  A month later, however, the fear and nausea returned in full force because Carmen was too embarrassed to tell her hairdresser that she still suffered from panic.  Depressed, Carmen stopped therapy for several months.

When Carmen returned to treatment, she presented a handwritten note describing what she wanted to do in therapy. It contained a three-pronged approach that included: 1) exposure; 2) mindfulness and acceptance, and 3) self-compassion.  Taking day trips away from home would de-condition her fears; anchoring her attention in present-moment sensory experiences, such as the soles of her feet contacting the ground, would help her tolerate the sensation of nausea, letting it come and go, and telling people about her difficulties would help dissolve her shame.  She called the whole plan, “internal acceptance” learning to accept her experience and herself wherever she went.  Her therapist felt gratified that some part of Carmen had been listening during the previous year of apparently zero progress.

The following week, Carmen proudly returned to therapy having completed more in vivo exposure (shopping, visiting friends, jogging) than ever before.  During the next two years, she gradually overcame her many fears.  It was a rocky road, but when Carmen couldn’t accomplish what she planned, she reminded herself that she was “not to blame.”  When she started feeling nauseous, she pulled out an airline bag and waited for the sensation to pass.  Eventually she volunteered at her church’s soup kitchen, the first of many steps to building a new life.

What happened here?  This case illustrates the power of compassion and wisdom in psychotherapy.  Carmen couldn’t stop fighting her fear of vomiting, which only made it worse, until she felt the fullness of despair about her situation and responded to her misery with warmth and engagement rather than self-criticism, shame, and withdrawal.  For Carmen, like many other patients who feel fragile or defective, first she had to begin to accept herself in her brokenness before she could face what she feared -in this case panic and vomiting in social settings.  Compassion was the missing link. In the midst of her frustration and despair, Carmen felt the compassionate attitude of her therapist.  This gave her courage to tell her hairdresser about her panic, who also responded sympathetically.  Finally, Carmen was able to give kindness and understanding to herself.

Wisdom also played a key role.  Wisdom allowed her therapist to feel Carmen’s despair without considering himself a bad therapist, to resonate with Carmen’s pain while maintaining perspective and hope, to work neither too much nor too little, and to let Carmen be the expert on her own life.  He helped create an atmosphere of curiosity, ease with uncertainty, and mutual regard.  Carmen’s own wisdom unfolded in multiple ways.  She began to look at her problems from a new, broader perspective, recognize the catastrophic, unrealistic meanings that vomiting had acquired; take her frightened, self-critical thoughts less seriously tolerate discomfort as ‘not me”; see setbacks and failure as part of life, and commit herself to meaningful activity with others.

Exercises to Practice

Every modality of psychotherapy presented in the book, without exception, emphasizes curiosity, observation, and acceptance rather than reactivity and judgment as pre-requisites for the cultivation of wisdom and compassion in psychotherapy, in life.  May these exercises help cultivate those pre-requisites.

[from Chapter 7: Cultivating Compassion in Psychotherapy by Christopher Germer]

Soften, Soothe, and Allow

Sit in a comfortable position, reasonably upright and relaxed.  Close your eyes, fully or partially.  Take a few deep breaths to settle into your body and into the present moment.

Find your breath in the heart region and begin to track each breath with gentle, mindful awareness.

After a few minutes, release your attention to your breath and let your attention be drawn to the place in your body where a difficult emotion can be felt most strongly.  For example, it it’s anger, you might feel tension in your stomach If it’s grief, you might feel hollowness in your chest.

Soften into that location in your body.  Let the muscles be soft without a requirement that they become soft, like simply applying heat to sore muscles.  You can say, “soft…soft…soft…” quietly to yourself to enhance the process.   Remember that you are not trying to make the sensations go away – you are just being with them with loving awareness.

Now soothe yourself for struggling in this way.  Put your hand over your heart and feel your body breathe.  Perhaps kind words arise in your mind, such as, “Oh my dear, this is such a painful experience.  May I find more ease and well-being.”

If you wish, you can also direct kindness to the part of your body that is under stress by placing your hand on that area.  It may help to think of your body as if it were the body of a beloved child.  You can say kind words to yourself, or just repeat “soothe…soothe….soothe.”

Finally, allow the discomfort to be there.  Abandon the wish for the feeling to disappear.  Let the discomfort come and go as it pleases, like a guest in our own home.  You can repeat “allow…allow…allow.”

“Soften, soothe and allow.  Soften, soothe, and allow.”  You can use these three words like a mantra, remind yourself to incline with tenderness toward your suffering.

If you experience too much discomfort with an emotion, stay with your breath until you feel better.

Slowly open your eyes when you’re ready.

Soften, Soothe, and Allow as a practice establishes a more compassionate relationship to emotional pain in the physical, emotional and psychological realms, respectively.  After a while, simply saying the words soften, soothe, allow can evoke a compassionate state of mind.

Five Pathways to Self-Compassion

Physical: Soften the body; stop tightening up (e.g., breathe deeply, take a warm bath, pet the dog, soften the belly, exercise, have sex, take a nap.)

Mental:  Allow thoughts to come and go, stop fighting them (e.g., do concentration or mindfulness meditation, prioritize, think of death, pray, “Thy will be done.”)

Emotional: Befriend feelings, stop avoiding them (e.g., do loving-kindness meditation, put your hand on your heart; practice forgiveness of self and other, listen to soothing music; ask, “What would your best friend say now?”

Relational: Connect safely with others, stop isolating (e.g., do compassionate image meditation, share lunch, express gratitude to an old friend, make amends, volunteer.)

Spiritual: Commit to larger values; stop “selfing” (e.g. engage in prayer meditation, share your faith, walk in nature, make peace, commit a random act of kindness, speak the truth.

Equanimity

The following equanimity phrases are adapted for clinical practice form traditional phrases used in early Buddhist mind training:

Everyone is on his or her own life journey.

I am not the cause of my patient’s suffering, nor is it entirely within my power to make it go away, no matter how much I wish I could.

Although this moment is difficult to bear, it remains a privilege to help.

[excerpted from Chapter 17 Anxiety Disorders by Judith Jordan and Janet Surrey]

Inviting A Difficulty In and Working With It Through The Body

1.  Before you begin this exercise, think of a difficulty you’re experiencing right now.  It doesn’t have to be a significant difficulty, but choose something that you find unpleasant, something that is unresolved.  It may be something you are worried about, an argument or misunderstanding you’ve had, or about which something you feel angry, resentful, guilty, or frustrated.  If nothing is going on right now, think of sometime in the recent past when you felt scared, worried, frustrated, resentful, angry, or guilt, and use that.

2.  Notice the way you are sitting in the chair or on the floor.  Notice where your body is touching the chair or floor.  Bring your attention to your breath for a moment.  Notice the in-breath…and the out-breath….Now gently widen your awareness, take in the body as a whole.  Notice any sensations that arise, breathing with your whole body.

3.  When you are ready, bring to mind whatever situation has been stirring up difficult emotions for you.  Bring your attention to the specific emotions that arise and any reactions you have to those emotions.  And as you are focusing on this troubling situation and your emotional reaction, allow yourself to tune in to any physical sensations in the body that you notice are arising…becoming aware of those physical sensations…and then deliberately  but gently directing your focus of attention to the region of the body where the sensations are the strongest in the gesture of an embrace, a welcoming…noticing that this is how it is right now….and breathing into that part of the body on the in-breath and breathing out from that region on the out-breath, exploring the sensations, watching their intensity shift up and down from one moment to the next.

4.  Now, see if you can bring to this attention an even deeper attitude of compassion and openness to whatever sensations, thoughts, or emotions you are experiencing, however unpleasant, by saying to yourself from time to time, “It’s OK.  Whatever it is, it’s already here.  Le me open to it.”

Stay with the awareness of these internal sensations, breathing with them, accepting them, letting them be, and allowing them to be just as they are.  Say to yourself again, if you find it helpful, “It’s here right now.  Whatever it is, it’s already here.  Let me be open to it.”  Soften and open to the sensation you become aware of, letting go of any tensing and bracing.  If you like, you can also experiment with holding in awareness both the sensations of the body and the feeling of the breath moving in and out as you breather with the sensations moment by moment.

5.  And when you notice that the bodily sensations are no longer pulling your attention to the same degree, simply return 100% to the breath and continue with that focus as the primary object of attention.

6.  And then gently bring your awareness to the way you are sitting in the chair, your breath, and when you are ready, open your eyes.

[Excerpted from Chapter 21: Mindful Parenting as a Path to Wisdom and Compassion by Trudy Goodman, Susan Kaiser Greenland, and Daniel J. Siegel.]

Clear Mind Activity

1.  Take a clear glass cylinder full of water, put it on a table, and ask you children to look through and see what’s on the other side.  They’ll probably see you or whatever’s sitting on the tabletop.

2.  Pour a cupful of baking soda in the water and shake the cylinder.  What does it look like now?  Can they still see through to the other side?  Probably not.  The baking soda clouds the water and obscures their vision.  Just like baking soda in water, thoughts, emotions, and stressful life events can cloud our perspectives.

3.  After a minute or two, take another look at the water.  What happens when you leave it alone?  Sure enough, the more the water rests, the more the baking soda settles and the clearer the water becomes.  Soon all of the baking soda will settle to the bottom of the cylinder and your children will be able to see through the lass again.  Does the baking soda disappear entirely?  Not, but it has settled to the bottom of the cylinder and no longer clouds the water.

Just as the baking soda doesn’t disappear in the cylinder, all of life’s challenges don’t disappear if you practice mindfulness.  But mindfulness does give us a way to maneuver the challenges of daily life.  By resting in the steady rhythm of our breathing, the thoughts, emotions, stresses, and strains of daily life settle and our perspectives become clearer.

Resources

Chris Germer and Ron Siegel are clinical psychologists in private practice in the Boston area, both on the faculty of Harvard Medical School, both dedicated teachers of mindfulness, acceptance, and compassion in workshops and conferences around the world.   They co-edited Mindfulness and Psychotherapy.  Chris is the author of The Mindful Path to Self-Compassion.  Ron is the author of The Mindfulness Solution: Everyday Practices for Everyday Problems.

Wisdom and Compassion in Psychotherapy: Deepening Mindfulness in Clinical Practice by Christopher K. Germer and Ronald D. Siegel.  Guilford Press, 2012.

For more information on trainings in mindfulness, compassion and psychotherapy:

The Institute for Meditation and Psychotherapy:

Mindful Self-Compassion:

Self-Compassion training:

Compassion Focused Therapy:

Internal Family Systems: